Hirsutism: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin and mucous membranes
      • Abdominal wall and inguinal region (groin area) [objective evaluation of distribution/quantity of hair: increased hairiness of the terminal hair (long hair) of the female according to male distribution pattern in the following areas:
        • Of the sideburns (of the jaw area near the ear), the upper lip and on the chin.
        • Of the upper sternum area, around the areolas.
        • From the navel – pulling in the midline to the pubic hair. The pubic hair itself extends to the thighs. Instead of an ideal-typical sharply defined triangular shape, this creates rather a broad rhombus shape.
        • Thighs, lower legs as well as the forearms.
    • Other features to consider:
      • Acne
      • Alopecia androgenitica (androgenic baldness).
  • Gynecological examination
    • Inspection
      • Vulva (external, primary female sex organs) [in virilism/masculinization: enlargement of the clitoris].
      • Vagina (vagina)
      • Cervix uteri (cervix), or portio (cervix; transition from the cervix (cervix uteri) to the vagina (vagina)), if necessary, taking a Pap smear (for early detection of cervical cancer).
    • Palpation (bimanual; palpation with both hands) of the internal genital organs.
      • Cervix uteri (cervix).
      • Uterus (uterus) [Normal: anteflexed/angled anteriorly, normal size, no tenderness].
      • Adnexa (appendages of the uterus, i.e., the ovary (ovary) and uterine tubule (fallopian tube)) [Normal: free]
      • Parametria (pelvic connective tissue in front of the cervix to the urinary bladder and on both sides to the lateral pelvic wall) [Normal: free].
      • Pelvic walls [Normal: free]
      • Douglas space (pocket-like bulge of the peritoneum (abdominal wall) between the rectum (rectum) at the back and the uterus (uterus) at the front) [Normal: clear].
    • Inspection of the mammae (breasts), right and left; nipple (nipple), right and left, and skin [Normal: unremarkable; increased pubescence of the terminal hairs (long hairs) of the female according to male distribution pattern in the upper sternal area, around the areolae]
    • Palpation of the mammae, the two supraclavicular pits (upper clavicle pits) and axillae (axillae) [Normal: unremarkable].
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.